Interview with Doximity Co-Founder Nate Gross

I recently caught up with Nate Gross (@ng), co-founder of Doximity (I recently caught up with Nate Gross (@ng), co-founder of Doximity (@Doximity), to hear about how the company is building out the social graphs of physicians. Earlier this year, Doximity hit a milestone — doc #200,000 — and Nate filled me in on where the company has been, and where it’s going.

Have a listen to our entire conversation, and see the transcript below.

Doximity is essentially Linked In for physicians. It’s a real-name on-line network that docs can use to connect with their existing network and beyond. The company has pre-populated profiles based on licensure information, and allows docs to claim their profiles and hit the ground running. It’s a secure HIPAA-compliant platform which allows for sharing of attachments (which could be lab results, images, etc.)

One interesting development as the network has grown is that Doximity has had to provide physician members with toll-free fax numbers (to the team’s chagrin) because that’s still the way most information flows to and from physician offices.

The platform is used for referrals, curbside consults, recruitment, small chunks of consulting work and more. Recently added features include the ability to access, save, share and discuss journal articles instantly, potentially reducing the fabled 17-year lag between publication and integration of research into practice. The Cleveland Clinic has a CME program on Doximity. Finally, the company wants to broaden its appeal as a platform for other services, so it is opening up its API to developers.

HealthBlawg Interview with Nate Gross, cofounder of Doximity

September 17, 2013

David Harlow: This is David Harlow with HealthBlawg and I am speaking today with Nate Gross, Co-Founder of Doximity. Hi Nate, thank you for joining us.

Nate Gross: Hi David. Thanks so much for having me.

David Harlow: A pleasure. So I am speaking with Nate from his offices on the left coast and he will be in Boston soon for the Connected Insight Summit on Network Analytics and I am hoping to hear something interesting about what’s happening with the network at Doximity, but before we get into some details Nate, could you give us a thumbnail sketch of Doximity and where your network stands today?

Nate Gross: Yeah, absolutely. So often in the media Doximity gets described as a LinkedIn for doctors and the assessment you know while limited is actually a good foundation on how to describe it. We are a professional network that connects medical professionals through a secure platform and the goal of the platform is to help these doctors deliver faster, more efficient and also smarter treatment. A key difference between Doximity and other social networks in addition to the security features is that Doximity has built much of its network in advance. And so in a way we are actually a directory of every physician in the United States and we have sizeable CV’s on each of these physicians, which means that unlike many smaller networks where you are just hoping to find a doctor and if you do you may find the most tech-savvy one but maybe not the perfect one for your patient. We want physicians to be able to find anyone that they would look up outside of the online space just in a more efficient way using online tools. So a physician for instance would use Doximity to find say the right medical expert for their patient, maybe they need, a orthopedic knee surgeon who speaks French and lives within thirty miles from Sacramento and takes Aetna Health Insurance and trained at a top ten hospital and we can identify that provider immediately and then the physicians can get in touch just like they always would or perhaps —

David Harlow: And if the specialist is not already a member of Doximity then your directory function allows someone to reach out through another communications platform?

Nate Gross: Yeah, absolutely. We have secure messaging and that’s an important feature of the site because for the physicians that use it, it does save them a lot of time. We also try to have as many convenient direct lines to the doctors as possible. If they want to use their regular cell phone or the landline in their hospital or if they want to send a fax we help them send a fax faster. For us the goal is efficiency of their existing conversation modalities and we expect over time they will transition to the more convenient digital features that we offer, but by no means are we forcing those upon the doctors. We just want to speed up what they are already doing.

David Harlow: Sure, and you alluded to the fact that information, not just messaging, can be shared through this platform. Is that right, so we are talking test results, imaging, things like that?

Nate Gross: Yeah, you know we don’t obviously know the content of the messages that physicians are just sharing with one another because everything is very much encrypted end to end and in transmission. And we do enable them to share high resolution images, PDFs, lab reports and many times that’s physician to physician, in some cases it’s physician to group of physicians, among a clinic or a hospital department or perhaps between hospitalist and a group of consulting cardiologists for instance, often within an existing institutional structure or sometimes exploring new sorts of expertise. And there may be a physician in Montana, or, actually our first early adopter state was actually Alaska and there the physicians are just so far apart that they don’t get that daily water cooler discussion that physicians say at Brigham and Women’s Hospital in Boston would get, where they could just float a tough case that they are having, past a group of diverse experts. But thanks to the network, they can track those folks down, see who they know in common, see if they should trust that answer and listen to the advice.

David Harlow: Right. And are there typically multiple connections within this network? Does a single physician have a couple dozen connections? More? If you go on LinkedIn, people’s profiles say they have five hundred or a thousand connections, is that the kind of level of connectivity that you are looking for?

Nate Gross: You know it is, we obviously don’t want to dilute the experience, but we also want to help physicians find whoever they need to find. And so there is a variance and I will go into some of that at the Connected Insight Summit in Cambridge when I talk, but in total we have around ten million connections between physicians across the entire network. And this is with a membership base of two hundred thousand doctors, so that’s about just under 30% of US doctors have actively signed up for Doximity and are building out their social graph. Now certain specialties may have a broader connection base and sometimes those connections are for different reasons. For instance if you are a specialist, maybe a plastic surgeon or an orthopedic surgeon building out your practice you may find that many of your connections are going out to family practice physicians, or sports medicine physicians, trying to make yourself available for more potential referrals. If you are a hospitalist your connections may be within the hospital that you are working at, among the specialists, so that you can quickly coordinate care as well as to a lot of primary care physicians that your patients are coming in from. So it differs, but just as an example, the 200,000th physician to join Doximity which was a couple months back he was an oncologist, he had been invited to join Doximity from a local surgeon and you know that is a couple day process where his identity was verified and he completed his online CV, but over that period he built out a network graph of about forty other colleagues and that included surgeons at the same hospital as well as looking further back a lot of doctors have found it useful to connect with people that they went to residency with for instance that they have lost touch with because you remember for most physicians it’s a pre-Facebook generation, but the fact that we already know who their residency classmates and medical school classmates are we can enable those connections more easily and sometimes that can be great just for getting back in touch or saying oh, I dated that person, and now they’re in Colorado and other times you didn’t know that, oh, it turns out that one of my residency classmates lives forty miles away from me and I actually am looking to expand my practice there and this is a perfect opportunity to reconnect.

David Harlow: What sorts of feedback do you get from users about how they are using the platform?

Nate Gross: That’s one of our challenges because we get a lot of feedback and a lot of ideas. See there is not just one type of doctor, of course you have academic versus private practice, old versus young, specialist versus primary care, rural versus urban and so there is a lot of different axes to the graph of products that we design. But for the most part we see a lot of demand around improving efficiency to communication specifically when it involves coordination of care, so one of the first features that we started building was secure messaging feature for instance and it’s great, it’s kind of like your cell phone on steroids, HIPAA-compliant, secure texting and there is obviously a lot of development in the US in this area over the past year. But one of the hurdles that we are running into is in the feedback we are getting back from doctors, they are saying well yeah this is great, but I just don’t know if the doctor that I need to contact is also going to be using the service right now and so I am too hesitant to do it and so while you might see pockets of these, this communication occurring within say a hospital where everyone adopts it at once after a champion sort of endorses it, it wasn’t really being used for broad clinical care until we could get a little more critical mass and so what we did was based on physician feedback, we did something a little embarrassing because we always had sayings around the office that we were going to kill the pager and we were going to kill the fax machine, but instead we decided to embrace it and go backwards-compatible and we now give every physician that wants it their own 1800 fax number and they can send and receive faxes from their phone, which sure is a little more roundabout compared to a secure messaging platform, but you know you can send and receive faxes with anyone in the country no matter how much of a technophobe they are and so it allows the folks who do want to embrace technology to do so and conveniently zoom in on those factors and read them and sign them with their finger on their iPad. But not feel like they are forcing everyone at once to jump on to a new platform and you can trust that you are still using that the common currency of medical communication, which right now is the fax.

David Harlow: Great, well that’s I think an important step to have that backwards compatibility in order to be able to have folks continue their existing conversations. I am wondering if you could tell me about your revenue model. One comparison that springs to mind — though it’s different — is Sermo, though you are using real names here, and part of the revenue model with Sermo I understand was, essentially, one way or another allowing nonprofessionals to enter the conversation if you will. I wonder if you are doing something similar or something different.

Nate Gross: That’s a really great question. We are very cognizant of the sentiment of our physician members and what we have learned through all of that is that physicians need a private community, especially when they use their real names which as you alluded to Doximity is a name identified professional network and physicians are staking their reputations on what they say and they are putting themselves out there for really the first time in digital history, whereas before they have been very hesitant to post on say the comments of a blog or on insecure social mediums like Twitter and Facebook without the, maybe not guaranteed, but a shield of anonymity. And so we respect that and we make sure that the physicians are able to have this private community — I mean there are no banner ads, there are no outside prying eyeballs and instead we have been able to develop a business model that’s around the same sort of things that physicians are doing. We don’t charge physicians for the service, but we have learned that physicians really do care about building out their careers in a protected digital environment and they want to be able to find the exact the person they need based on the information they are putting on their CV’s and so we allow the same opportunities for doctors who are looking to expand their careers and I will give you an example. When they sign up doctors can say oh, I am interested in expertise consulting and if they are they can opt into a service where they can say let’s say that they’re the world expert in Hepatitis C and somebody on Wall Street has a question about Hepatitis C because maybe a new clinical trial, a drug or something that’s come out.

Historically in other social mediums the way they would get their answers they would send out lots of surveys or they would pry into what physicians were saying on other online arenas. But here the physician can say that they are interested in consulting, we can broker an introduction, but we say, hey, we are only going to introduce you to the physician if you promise to pay the physician at least whatever they want say, six hundred dollars an hour and now that doctor has a real reason, being able to provide for their family, to have a short brief conversation and the other side is quite happy because they get their answer quickly. Another way this can be useful is around careers — that’s the fastest growing part of our business right now.

It’s normally very hard for doctors to find the right fit for a job and in the past this hasn’t been as much of an issue because physicians have really stayed in one spot for a long time, but as you are well aware we are seeing a lot more absorption into larger hospital systems. We can say that the flip of cardiologists from being two thirds in private group practices to now two thirds being hospital affiliated for instance. And for the first time docs are realizing that due to either that change or new financial pressures or just a younger generation of doctors who are looking for something different out of their career they want to find a slightly different environment. And in the past that’s been solved by things that are essentially Craigslist or by headhunters and they are both incredibly inefficient systems, but if you have all the curriculum vitaes of doctors in one spot you are able to much more easily when you need to find say a cardiothoracic surgeon to move to Montana that’s normally a tricky task, Montana is beautiful, except not that many doctors have a connection with it.

But we are able to usually identify which doctors do have a connection with Montana and those doctors can say if they are interested or not and looking for new job opportunities, but beyond that, these doctors typically say oh there is a new job opportunity within thirty minutes of Lakes and that’s all you learn about it but because we are able to represent the physician side of the equation here we are able to say, oh, no you are only able to reach out if you put the salary right in the title that you know so the doctor is able to know where it is, what it’s worth, how much calls are there and from the physician side they finally get the feel like for a change that they are able to specify their demands, they want to be a hospitalist and live in Seattle and Portland and make this much money with this much call and they only get exact matches for that so no more spam and no more inefficient market for either side and so those kind of expertise introductions are what we are basing our economic model on right now, which allow us to provide this secure and physicians-only experience to our users for free.

David Harlow: So the job listing or the information seeking is done at a cost to the third party?

Nate Gross: Exactly.

David Harlow: Do you have a sense of how many of the users opt in to use some of these tools versus just using the doctor-to-doctor communication platform?

Nate Gross: Well it varies by types of physicians and where they are in their career and things like that, but I can tell you that we see absolutely incredible, I can’t show the exact number but just mind-blowing numbers of interest when there is an opportunity that could be a fit in physicians looking at their opportunities and I think a lot of that is because we have gone to such lengths to protect the doctors, so you know again the example that most job offers really give you no juicy details about the salary and things like that and we insist on it and because of that even if you are not looking for a job right now doctors often want to know what they are worth, it’s good to know that you have a job offer for a couple hundred thousand dollars across the country because maybe that will help you over the next six months decide if it’s even something that you are interested in and so we are adding not only an additional layer of targeted introduction for both sides, but also a new layer of transparency that doctors haven’t seen before and so they are really, almost all are interested in just at least learning what they are worth, we get very little opt out from the experience.

David Harlow: Sure, so do you have any new features that you might be rolling out in the future or is this just sort of a slow organic growth that you are seeing in the product?

Nate Gross: So yeah two new features that have picked up a lot of stream recently. One of them is called Doc News and what it is essentially is it’s a way for physicians to connect around academic literature and medical knowledge which has been very hard to do, historically, if you think about it you know doctors read journals yes and the academically affiliated ones have unlimited journal access although they don’t have much time and the private practice doctors have limited journal access, and whatever happens to come in the mail and then there is the annual conference that some of them go to but it’s really just people in their own specialty and there is the water cooler discussion network and maybe there is some information that drug reps provide, but what we have done is we have managed to sync Doximity with the publishing output of every journal in the country through the help of the US Government and sources like PubMed.

And now doctors can read what’s going on in medical literature and then more importantly, immediately react, read it critically, connect post your opinions and anecdotes and thoughts on the literature and have it read by other people at the same time. And because we know what doctors are interested in based on their profile and they can also specify reading preferences, if you are that interventional cardiologist that likes percutaneous aortic valve replacement you will never miss an article on that subject, thanks to our system. And more importantly you can see what other people are thinking about that same literature in real time, so we have conversations between study authors and readers the same day the article is published, which compared to say letters to the editor that get published once a month and then another month for a response and it’s on the back page of journal and nobody reads it, it’s a lot more real-time and there is this number that’s going around that just takes 17 years for medical knowledge to disseminate in this country.

David Harlow: Just what I was going to ask you about …

Nate Gross: Yeah.

David Harlow: The 17-year problem.

Nate Gross: Exactly and I am not claiming we are going to completely solve it, but that’s one of the things that I mean, now, we have conversations occurring in 17 minutes between the study author when something is published and the readership and they can go into more detail and share things with their colleagues and it’s absolutely amazing just hundreds of articles everyday are being read, digested and shared. And a new development there is — we actually are working with the Cleveland Clinic to add an additional perk to the feature which is CME. Historically Continuing Medical Education is a very heavy, messy, process where you have to fill out a large number of surveys and does it help your practice and how and it’s kind of the same redundant survey over and over and over and mail it in and hope you get there the stamps back. And with our service if you are using Doximity in an active way to look up topics that you are interested in, in reading those articles, we know that you are reading those articles and we know who you are and so we can speed up the process so that it’s incredibly convenient in every end of the semester you can kind of go through with just a very quick fill out the form and then instantly – bam! — you get all this category one CME credit from the Cleveland Clinic based on the information that you have read on our platform over the past year.

And so we are really excited about that. I hope it’s going to make continuing medical education much easier for doctors. And then the other new feature that we are working on, which I am going to go into more detail at the conference is our API. There is a growing digital health community– hundreds of new startups — and a lot of them we found are going through the same hurdles that we are going through in terms of verifying physician identity and dealing with a lot of very messy information. And I think the more doctors that we can get moving on to the digital platforms that aren’t necessarily electronic medical record, but a much more clever novel solving one particular problem you know with this, say an iPad app that lets you share CT scans and discuss them securely with the radiologist things like that. Those are things that we are actually able to help through our API. And so that’s kind of the next big wave that we have been working on over this summer and have some data to share at the conference about, which I think is going to be pretty exciting how we can turn Doximity into a platform.

David Harlow: Well that sounds very interesting. I am looking forward to hearing more about that at the conference and to see you at the Connected Insight Summit and I wanted to thank you again for taking the time to speak with us.

Nate Gross: All right, well, hey thanks so much for your time as well and I look forward to seeing you at the Connect Insight Conference.

David Harlow: Thanks. This is David Harlow at HealthBlawg. I have been speaking with Nate Gross, co-founder of Doximity.